{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:54:42Z","timestamp":1791251682261,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tenapanor is a mechanistically distinct treatment for hyperphosphatemia in hemodialysis and can reduce phosphate\u2010binder pill burden in selected patients. However, its real\u2010world value is constrained by bowel effects, particularly diarrhea, which commonly emerges early after initiation and may lead to treatment aversion or discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>In this review, treatment persistence refers to the ability to continue tenapanor through the early bowel\u2010symptom period without permanent discontinuation due to gastrointestinal symptoms or treatment aversion, while maintaining clinically meaningful phosphate control. Current evidence indicates that tenapanor\u2010associated bowel effects are clinically bidirectional. They may improve stool consistency and reduce laxative dependence in constipation\u2010prone patients, whereas the same bowel shift may cause loose stools, urgency, discomfort, dialysis\u2010session anxiety, and discontinuation in others. Longer\u2010term studies suggest that patients who remain on therapy may maintain phosphate control with fewer concomitant phosphate\u2010binder tablets, although early discontinuation and completer effects require cautious interpretation. A persistence\u2010oriented approach includes baseline bowel\u2010habit assessment, region\u2010specific and label\u2010consistent initiation and dose adjustment, individualized timing around dialysis sessions, review of concomitant bowel\u2010active medications, anticipatory patient education, and monitoring for fluid and electrolyte consequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tenapanor\u2010associated bowel effects are a central implementation barrier rather than a secondary tolerability issue. Persistence may be improved by matching treatment to baseline bowel phenotype and using a tolerability\u2010first, safety\u2010conscious continuation framework. Prospective studies should define predictors of persistence and validate supportive strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hdi.70099","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T03:28:46Z","timestamp":1781494126000},"page":"698-707","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tenapanor\u2010Associated Bowel Effects in Hemodialysis: Persistence Barriers and Practical Continuation Strategies"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6851-1542","authenticated-orcid":false,"given":"Yoshitaka","family":"Furuto","sequence":"first","affiliation":[{"name":"Department of Hypertension and Nephrology NTT Medical Center Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology NTT Medical Center Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Namikawa","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology NTT Medical Center Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dai","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology NTT Medical Center Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Shibuya","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology NTT Medical Center Tokyo  Tokyo 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